acropustulosis

Schachner noted that the differential diagnosis of noninfectious, usually benign neonatal vesiculopustular lesions includes acropustulosis of infancy; eosinophilic pustular folliculitis; erythema toxicum neonatorum; miliaria crystallina, rubra, or profunda; transient neonatal pustular melanosis; and neonatal sucking blisters.

If cytology reveals polymorphic neutrophils, differential diagnoses include transient neonatal pustular melanosis, infantile acropustulosis, bullous impetigo, and pustular psoriasis.

The last phenomena presents with recurrent crops of pustules in the acral area, which is acropustulosis of infancy or postscabetic pustulosis.

Further removed from active infection, some children will develop recurrent crops of extremely pruritic papules and pustules, especially on the feet called acropustulosis weeks to months after treated infection; a more nodular hypersensitivity reaction called "postscabetic nodules" also can occur and may take months to years to fully resolve.

Infantile Acropustulosis: Small intensely itchy papules appear between 2-10 months of age.

Infantile acropustulosis. Dermatologia Argentina 2013; 16: 268-71.

However, failure of the anti-scabies treatment, absence of positive personal and hygienic history and progression towards the deterioration of existing situation lead to the establishment of a history and clinical based diagnosis of Infantile Acropustulosis. The treatment was started accordingly and soon after starting treatment, the patient showed the signs of recovery.

We report a similar rash in an infant who was repeatedly treated as scabies but in the end turned out to have an uncommon underlying diagnosis of Infantile Acropustulosis.